By Kara Johnson-Hufford
A teen struggling with mental health issues caused by a rocky home life finds support in their school-based clinic. A new mother facing postpartum depression seeks help at her local crisis clinic, ensuring stability for herself and her young family. A rancher, overwhelmed by the demands of maintaining their operation, shares stories and solidarity over a cup of coffee with neighbors in the same predicament.
These are real scenes playing out every day across Colorado, where community mental health centers provide essential community-based care – one day at a time, one life at a time. Initially, these centers focused on serving Coloradans with serious mental illness. Over the years, they expanded their services to meet the broader needs of the community, offering support for substance use disorders, school-based services, co-response and other justice system services, crisis services, and disaster behavioral health events. Providers have also strengthened case management services to ensure individuals experience continuity in their care, addressing issues before they escalate into crises and preventing more intensive, and costlier, behavioral health interventions.
Despite their obvious benefit, the future of these critical services is at risk. Why? The reason is simple: many of these essential services often lack an adequate and sustainable funding source. The flexible, reliable funding that allowed community mental health centers to expand services based on community need is in danger of being drastically reduced. We are at risk of losing programs and decades of hard-fought-for infrastructure that are vital to the health and well-being of our communities because they do not generate revenue or are not adequately reimbursed.
Colorado’s new safety net funding model is undergoing a sea-change. In Medicaid, the funding model is moving to a prospective payment system, which resembles the direction that federal funding for Certified Community Behavioral Health Clinics is going – a step in the right direction. Unfortunately, Colorado’s model doesn’t adequately cover services that don’t fit neatly into a billable framework – services that are essential to communities and people but uncompensated.
This raises a critical question: If community mental health centers aren’t providing these lifesaving and life-sustaining services, who will?
As we heard in a recent legislative listening session, safety net providers – physical and mental health providers alike – are grappling with increasing levels of uncompensated care. In mental health, we’ve seen a 20% increase in the number of people who need care. Over 40 primary care safety net clinics across Colorado that don’t receive federal support are experiencing a 10% to 25% rise in uninsured patients each month, compared to the previous year. Colorado’s hospitals have seen a 50% increase in uninsured patients in their emergency departments, and federally qualified health centers are reporting a 30% rise in uninsured patients.
These numbers represent real people—and they are pushing providers to make tough decisions. Sadly, several of our state’s safety net behavioral health providers have already had to announce layoffs and program reductions. And others may soon follow, potentially cutting or eliminating services that fall outside their core safety net roles, just to keep providing the most essential care.
But despite these challenges, there is hope. Colorado has faced tough times before, and we have risen to meet them. We can do so again. Our safety net providers and clinics are doing remarkable, community-driven work at the local level, and they need our support to continue. The question before us now is: can we come together to acknowledge the problem and find workable solutions? I believe we can.
With collaboration, commitment, and creativity, we can safeguard the future of our mental and physical health safety net. Together, we can ensure that every person in Colorado, no matter their circumstances, has access to the care they need—both now and in the years to come.